Under The Knife

Cubs Down

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Aramis Ramirez (45 DXL)
The Cubs have lost Ramirez for what they say will be a four- to six-week period, but let's take a look at the injury and see why I think it will be more. On first glance, the dive doesn't look like much, but it's one of those incidents where the wrong force applied in the wrong direction pushed the head of the humerus completely out of the "cup" of the glenoid fossa. Not only that, but it stayed out, requiring it to be reduced (popped back in) by a Brewers physician. That's not a good thing. With the video and multiple angles, we also know exactly how the head popped out. The force was up and back, almost at a 45-degree angle. If you watch the motion of his humerus as he lands on it, it's impossible not to see it, and given that motion, several people who I spoke with worried that he would have Bankart lesion, a type of shoulder defect that can not only be problematic to fix, but can cause further dislocations. Ramirez did have a similar type of injury, then called a separation, that may have predisposed him to this, though he's made similar plays on hundreds of occasions, I'm sure. It was simply the wrong force at the wrong time. It's not the dislocation itself, but the possible (probable?) internal damage caused by moving the humeral head out of place that has me thinking that this is going to go around the six- to eight-week mark, and even more if surgery is necessary.

Derrek Lee (5 DXL)Ryan Freel (0 DXL)
The news gets worse for the Cubs, with Lee heading for an MRI on his problematic neck. He's been dealing with a bulging disc off and on for several years, but it's always involved only minor discomfort. It would pop up as an annoyance for a few days, and then pass, but this time it's been almost constant since the beginning of the season, and Lee hasn't been able to get past it. The team is worried that some weakness, in addition to the pain, might be an indication that the disc is pressing on nerves and may require surgery. In fact, it likely will, but the question is whether or not they can get him through the season and turn this into an off-season project. The images will inform them, but with cervical discs, it's difficult to get much of a read on what type of therapies they've already tried and what they have left in their bag of tricks. Newest Cub Freel came off of the DL on Sunday, but he immediately pulled up lame. His hamstring was still tight, though he was able to pinch-hit (and get picked off). Freel is a reminder that, yes, you can be traded while on the DL; Freel has been very injury-prone over the past few seasons, in large part because of his all-out style.

Dustin Pedroia (3 DXL)Kevin Youkilis (5 DXL)
Everyone saw Pedroia pull up with a groin strain on Sunday night. He strained it running down the line, and while he fought to stay in the game, the Sox tend toward caution. They'll continue to do so over the next couple of days, especially with an upcoming cross-country flight mixed in. Pedroia's already been ruled out for Tuesday's game, giving him at least two full days for rest and treatment. The Sox tend to give up a day in order to keep an injury from getting worse, so don't read too much into this. Pedroia's lateral mobility and acceleration will be the problem areas, at least for the first few games. Youkilis missed the weekend, and like Pedroia, probably won't be back until Wednesday. The oblique is still 'catching' on swings, and while it's more an issue of soreness than of pain, the team is going to hold him out until they're sure that he won't exacerbate the situation.

Joakim Soria (25 DXL)
With everything that's been going right for the Royals, the thing that has not has been the team's health. While Alex Gordon's absence is noticeable, Soria is the player for whom they're most concerned. Soria's shoulder has been a continual problem since opening day, leading the team to send him to the DL just to try and calm things down and get them right. This is an acknowledgement that the short rest they gave him a few weeks back wasn't enough. The team continues to spin that there is no significant damage, just inflammation, but the symptoms match up very well with impingement. The move is retro to Friday, and team sources say that Soria will rest until the shoulder feels fine. It's difficult to put a time frame on this, but somewhere between the minimum and a month is reasonable, depending on how aggressive the rehab is, and how well his shoulder reacts to the rest and then to a strengthening program. I'll go toward the long end, and I'm worried that there's something more going on here.

Lance Berkman (5 DXL)
"Cartilage sprain?" As the kids on Twitter say, terminology fails. As any novice med-head knows, a ligament sprains, and muscles and tendons strain. Doctors aren't stupid and reporters tend to copy things well, and that tells us that Berkman actually does have a sprain and that the term used is more nebulous than wrong. In fact, the terminology leads us to exactly what the issue is. Berkman has a sprain of the TFCC. (I'll let you click through if you care about what it actually is.) The TFCC is both a cartilagenous mass and some ligaments connecting it on the medial (little finger) side of the wrist. Often injured in a fall as someone catches themselves, this sprain isn't as serious as a fracture would be. The tough bands tend to heal fairly well, though the team will watch the swelling. In the short term, Berkman will have the typical wrist-related issues, and he could lose some power and bat control, but probably not much time.

Joba Chamberlain (0 DXL)
Why doesn't anyone call for Philip Hughes to move to the pen? He throws hard, can't stay healthy, and hasn't sustained any success in a starting role. All that aside, Chamberlain continues to pitch well enough to keep his team in games, but not well enough to keep the calls to the bullpen away. He pitched with a broken blood vessel in the thumb of his pitching hand, but it didn't seem to be giving him any trouble during the game. He once again showed low velocity in the first inning, up until Aubrey Huff took him into the bleachers. Suddenly, his mid-90s heat appeared. Sources tell me that this isn't a warm-up or focus issue, but that it's a "conservation strategy" formulated by Dave Eiland. It makes sense, but it's also not working. I'd rather have Chamberlain (or any pitcher) give me five good innings rather than seven mediocre ones. Of course, that exposes the bullpen even more, which seems to be the fan's biggest concern.

Michael Young (3 DXL)
Young has made the shift to third base with almost no trouble. The move didn't cause his back problem, which is minor and something that he's dealt with before; the team simply held him out to make sure that he didn't do something to make it worse in-game. Young's the kind of player that a team can't say "turn it down a notch" to when they're sending him out on the field. It's a different situation than an all-out player like Freel, but it has to be treated the same way from an injury standpoint. The back is more a matter of soreness and discomfort now, but with some rest and treatment, it shouldn't be an issue going forward. If Young can play healthy for a week to ten days once he's back on the field, you can forget that this ever happened.

Chipper Jones (2 DXL)
You know this tune. Jones has a hyperextended right elbow and says that he'll play if he can throw. He told reporters that it would be "a day, at most." Yeah, nod your heads and prepare for him to get back out there too early and then say "wow, I shouldn't have done that." This is the pattern that Jones always uses, and that the Braves continue to allow him to follow. There were thoughts a few years back that as players became more powerful and teams less paternalistic, the superstars would not only have masseurs, personal chefs, and shady personal trainers, but also their own medical staffs. Jones doesn't have his own medical staff, but he might as well, the way these events go. Remember how the star QB at your high school never needed a hall pass? Same thing here. This is not a serious injury.

Quick Cuts: I haven't seen this written about or heard the question asked, so I'll try: Where's Manny Ramirez now? What will he do for the next month and a half? ... Xavier Nady's elbow treatment is going so well that rehab assignments are already being discussed. That he'll have to DH is the part of the equation being ignored. ... The Dodgers aren't expecting Hiroki Kuroda back until mid-June. ... Travis Hafner is taking batting practice and is expected back when eligible. ... Chien-Ming Wang will have a rehab start on Tuesday in Triple-A. ... Matt Capps is on track to be back in the pen on Tuesday. There is some question as to whether he'll immediately take the closer's role. ... Stephen Drew began his rehab in Reno, going 1-for-5, but avoiding having to face Steve Palazzolo. He's expected back in Arizona's lineup no later than Wednesday. ... Joe Crede is having some hamstring issues. Remember that hamstring and back issues are often interrelated, though sources insist that this is a garden variety hamstring strain. ... Troy Tulowitzki is still having some trouble with the quad strain that ended his season last year. That's never a good sign. ... Ricky Romero came through his first rehab start well. He'll have at least one more before coming back to the Jays. ... Josh Hamilton had no issues with his rehab stint and will be activated on Tuesday. ... Remember when I told you that Matt Harrison had changed something in his side work with Mike Maddux? Whatever it was, it worked. ... Chad Fox has another elbow injury and another career-threatening issue. He might have the record for most career-threatenings in a career.

Anything on Alex Gonzales (CIN)? Also, is Manny going to be getting drug tested while suspended? Given the rumors of his recreational drug use, 50 games off seems like an opportunity to pick up that sort of habit.

Manny's subject to the increased testing of the program. I'm sure he'll get tested. I'm NOT sure if he needs "clear time" -- you shouldn't get nailed twice for same offense. Not sure of what the policy is on that (I don't remember seeing it in the JDA) though I know the minor league policy only takes it into account on appeal. Checking on how long it takes the body to get HCG out from detectable levels.

Actually, just this morning I heard David Cone suggest that Hughes go to the pen. But any discussion of either young arm to the pen assumes what? That Pettitte will return and be successful next year? (To say nothing of 3 - 5 years from now.) That Wang will be serviceable going forward? That Burnett won't get hurt? The Yanks have a wealth of arms in their system -- if they have to adapt one of their most promising to the pen, it suggests severely wrongheaded talent evaluation (which may have in fact been the case, I dunno).

Misread physician... but still, I'm a bit surprised. I'd imagine that if the Cubs doctor was not available that the procedure to pop his shoulder back in would be done at a local hospital, and more importantly, that nothing would be done until some kinds of xrays were conducted.

I guess I picture the chain of events something like this:

Ramirez pops shoulder.
Ramirez is taken to a local hospital.
Ramirez gets an x-ray and other analysis/treatment from a hospital physician.
Ramirez gets his shoulder popped back in.

And not this:
Ramirez pops shoulder.
Ramirez gets his shoulder popped back in by the Brewers physician in the clubhouse.
Ramirez is taken to a local hospital.
Ramirez gets an x-ray and other analysis/treatment from a hospital physician.

Will the Aramis Ramirez shoulder injury have a long-term impact on his offensive production? I mean, say it takes a surgery, and 10 weeks; after that, will the Aramis Ramirez the Cubs expected to have in the line-up ever be available again in 2009?